ABSTRACT
Brown University School of Medicine Although serotonin reuptake inhibitors (SRIs) have clearly been established as the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), between 40% and 60% of patients remain unimproved after an adequate trial with these drugs. Adding agents that enhance serotonin (5-HT) neurotransmission to ongoing treatment in SRI-refractory patients has not yielded impressive results. The addition of neuroleptic medication to the regimens of treatment-refractory patients appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chronic tic disorder (e.g., Tourette’s syndrome). Controlled investigations of neuroleptic addition to ongoing SRI therapy are needed in OCD patients with concomitant symptoms of psychosis or schizotypal personality disorder (SPD) as well as in SRI-refractory trichotillomania and body dysmorphic disorder (BDD). Preliminary results from studies of the atypical neuroleptic risperidone indicate that it may be effective in subgroups of SRI-refractory OCD patients, and perhaps better tolerated than typical neuroleptics. One interpretation of emerging drug treatment response data is that both the 5-HT and dopamine (DA) systems may be critical to the treatment, and possibly the pathophysiology, of some forms of OCD.
